| 1. |
- Bucardo, Filemon, et al.
(author)
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Genetic susceptibility to symptomatic norovirus infection in Nicaragua. : norovirus susceptibility in Nicaragua
- 2009
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In: Journal of medical virology. - : Wiley. - 1096-9071 .- 0146-6615. ; 81:4, s. 728-35
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Journal article (peer-reviewed)abstract
- Host genetic resistance to Norovirus (NoV) has been observed in challenge and outbreak studies in populations from Europe, Asia, and USA. In this study, we have investigated if histo-blood group antigens can predict susceptibility to diarrhea caused by NoV in Nicaragua, Central America, and if this can be reflected in antibody-prevalence and titer to NoV among individuals with different histo-blood group antigen phenotypes. Investigation of 28 individuals infected with NoV and 131 population controls revealed 6% of non-secretors in the population and nil non-secretors among patients infected with NoV, suggesting that non-secretors may be protected against NoV disease in Nicaragua. Surprisingly, 25% of the population was Lewis negative (Le(a-b-)). NoV infections with genogroup I (GI) and GII occurred irrespective of Lewis genotype, but none of the Lewis a positive (Le(a + b-)) were infected. The globally dominating GII.4 virus infected individuals of all blood groups except AB (n = 5), while the GI viruses (n = 4) infected only blood type O individuals. Furthermore, O blood types were susceptible to infections with GI.4, GII.4, GII.7, GII.17, and GII.18-Nica viruses, suggesting that secretors with blood type O are susceptible (OR = 1.52) and non-secretors resistant. The overall antibody-prevalence to NoV GII.3 VLP was 62% with the highest prevalence among blood type B carriers (70%) followed by A (68%) and O (62%). All four investigated individuals carrying blood type AB were antibody-negative. Among secretors, 63% were antibody-positive compared to 33% among non-secretors (P = 0.151). This study extends previous knowledge about the histo-blood group antigens role in NoV disease in a population with different genetic background than North American and European.
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| 2. |
- Dahlblom, Kjerstin, 1950-
(author)
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Home alone : sibling caretakers in León, Nicaragua
- 2008
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Doctoral thesis (other academic/artistic)abstract
- Sibling caretaking, although common across time and cultures, has not been well researched from the carer’s point of view. In Nicaragua, ranked as one of the poorest countries in the Americas, sibling caretaking is common. The country’s historical background and its state of chronic poverty, widespread unemployment, loose family structures, and migration and mobility makes of the old practise of shared management child care a necessity. Households headed by sing¬le mothers constitute a particular Nica¬raguan charact¬eristic. Many children are expected to help in their own families and care for their siblings and other children living in their households. In its broadest sense sibling caretaking is a public health concern, and we conducted this study to widen the understanding of the phenomenon as it is represented in a setting undergoing a rapid social transition. The main objectives were to identify, describe and analyse the life situation of sibling caretakers in poor areas in León, Nicaragua, with focus on how they perceived it themselves. A combined qualitative and quantitative methodological design was used, mainly applying an ethnographic approach. A further ambition was to explore involvement of children in a participatory research process in accordance with the ‘Convention on the Rights of the Child’. The overall emotion expressed among the caretakers was pride, even if their situation often was characterized by stress and coping problems. They perceived their work as important for their families and they appreciated to fend for their siblings. Household work and nurturing of siblings were shaping the future lives of the caretakers and constituted part of their socialization. Even if many of these children achieve essential life skills as caretakers, they are at risk of falling behind as they grow older. Their long-term personal development is likely to be hampered by the obligations they have as caretakers. The carers' awareness of missing out on education was the most problematic issue for them. From a societal point of view, caretaking has negative consequences. The individual child is marginalised with limited access to basic education, contributing to overall low educational levels in Nicaragua. While the structuring conditions leading to sibling caretaking may be difficult to change, awareness of how these can affect children might make way for improvements in terms of access to school education and support from the society. The knowledge gained from this study should be further utilised to plan for interventions that take children’s perspectives into consideration.
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| 3. |
- Åsling Monemi, Kajsa, 1960-
(author)
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The Impact of Violence Against Women on Child Growth, Morbidity and Survival : Studies in Bangladesh and Nicaragua
- 2008
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Doctoral thesis (other academic/artistic)abstract
- The aim of this thesis was to explore the impact of physical, sexual and emotional violence against women of reproductive age and the level of controlling behaviour in marriage on child health and survival in two different cultural settings: Bangladesh and Nicaragua. Data were acquired from four quantitative community-based studies. In two studies, a cohort including a prospective two year follow-up of 3164 mother-infant pairs in rural Bangladesh was investigated. A third study was a case-referent study in Nicaragua including mothers of 110 cases of under-five deaths and 203 referents, and in a forth study an other cohort of 1048 rural Bangladeshi women and their 2691 children was followed until 5 years of age. Maternal exposure to any form of violence, including physical, sexual, emotional, and controlling behaviour was independently associated with lower body size at birth, increased risk of stunting and under-weight at 24 months of age, slower growth velocity during the first two years of life and a higher incidence of diarrhoeal episodes and respiratory tract infections. In the Nicaraguan setting, the children of women who experienced any history of physical violence had a two-fold increase in risk of death before the age of 5 years, and those whose mothers experienced both physical and sexual violence had a six-fold increase in risk of death. In Bangladesh, an association between violence against women and under-five mortality was found among daughters of educated mothers who were exposed to severe physical violence or a high level of controlling behaviour in marriage. In all four studies, lifetime violence experience among participating mothers was high (37-69%), and the timing was less relevant than the exposure to violence per se. In conclusion, this investigation revealed that violence against women severely affects child health and survival. The findings are especially relevant in a context of high level of child under-nutrition, morbidity and under-five mortality. Efforts for protecting women from all forms of violence are needed as part of the interventions for improved child health.
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| 4. |
- Herrera Rodríguez, Andrés, 1966-
(author)
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Heaven can wait : studies on suicidal behaviour among young people in Nicaragua
- 2006
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Doctoral thesis (other academic/artistic)abstract
- In developed countries, suicidal behaviour is recognised as a significant public health problem among young people, but there are few studies from developing countries on this subject. The present thesis aims at estimating the extent of the problem and at exploring factors related to suicidal behaviour among young people in a developing country, Nicaragua, using a combined quantitative and qualitative approach. Three studies were conducted between 1999 and 2006. In the first study, all hospital admitted suicide attempt cases in the area of León were assessed over a three year period. Secondly, a qualitative study using individual in-depth interviews was conducted with eight girls aged between 12 and 19 admitted to hospital after attempting suicide. Thirdly, a study using the Attitudes Towards Suicides (ATTS) questionnaire was conducted in a community based sample of 278 young people aged 15-24 years to assess own suicidal behaviours, attitudes towards suicide as well as exposure to suicidal behaviour among significant others. The hospital surveillance showed that suicide attempt rates were highest among females in the age group 15-19 years with a female rate three times that of males (302.9 versus 98.9 per 100,000 inhabits per year). Drug intoxication and pesticides were the most commonly used methods for the attempts. A consistent seasonal variation with peaks in May-June and September-October was found in each of the three years, possibly related to exam periods in schools. Findings in the qualitative approach led to a tentative model for pathways to suicidal behaviour based on four main categories: Structuring conditions, triggering events, emotions and action taken. Dysfunctional families, lack of confidential and trustworthy contacts and interpersonal conflicts followed by emotions of shame and anger were some important components in the model. The community studies showed that suicidal expressions (life-weariness, death wishes, suicidal ideation, suicide plans and suicide attempts) were common among young people where more than 44.8% of males and 47.4% of females reported some kind of suicidal expression. Gender differences were small. Exposure to suicidal behaviour among others was associated with higher levels of self-reported suicidal behaviour. The attitude study showed that boys had less pro-preventive attitudes than girls, possibly indicating their higher risk for completed suicide. Exposure to suicidal behaviour and own suicidal behaviour showed an association with specific patterns of attitudes. The findings should be taken into consideration when planning for prevention of suicidal behaviour among young people in a developing country like Nicaragua.
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| 5. |
- Herrera Rodríguez, Andrés, et al.
(author)
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Pathways to suicidal behaviour among adolescent girls in Nicaragua
- 2006
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In: Social Science and Medicine. - : Elsevier BV. - 0277-9536 .- 1873-5347. ; 62:4, s. 805-814
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Journal article (peer-reviewed)abstract
- Adolescent girls are the most frequent suicide attempters worldwide. However, there is little knowledge about pathways leading to suicidal behaviour among young people, in particular in low-income countries. This study explores the motives and processes related to suicidal behaviour among young girls in Nicaragua. Individual in-depth interviews were conducted with eight girls aged between 12 and 19 admitted to hospital after attempting suicide. The audio-taped interviews lasted 2–4 h and were transcribed, translated into English and coded for content. Grounded theory and content analysis were used to construct a theory of the mechanisms behind their suicidal behaviour. A tentative model exploring pathways to suicidal behaviour is described with four main categories: structuring conditions, triggering events, emotions and actions taken. The model illustrates the dialectic interplay between structure and actions taken. Actions taken were categorized as problem solving or various forms of escape where failure with either of these strategies resulted in a suicide attempt. Dysfunctional families, absent fathers and lack of integration into society were some of the structuring conditions that lead to emotional distress. Abuse, deaths in the family, break-up with boyfriends or suicide among friends acted as triggering events. A striking finding was the obvious narrative competence of the girls. Our findings indicate that suicide prevention programmes for young people must offer support from professionals, independent of their family and social networks. Institutions in the community in contact with young people with suicidal behaviour must develop communicative skills to offer a trusting environment mobilising the resources that young people have.
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| 6. |
- Valladares Cardoza, Eliette, 1963-
(author)
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Partner violence during pregnancy, psychosocial factors and child outcomes in Nicaragua
- 2005
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Doctoral thesis (other academic/artistic)abstract
- The objectives of the thesis was to explore partner violence during pregnancy in Nicaragua – its prevalence and characteristics, how women perceive, understand and cope with it, its association with specific child outcomes such as low birth weight (LBW), small for gestational age (SGA) and preterm birth, and possible pathways. A cross-sectional community-based study was conducted with 478 pregnant women and for a sub-sample of 147 salivary cortisol was measured. A case-referent hospital-based study was organized including 303 mothers immediately after delivery. In-depth interviews were conducted with women survivors to increase understanding of partner violence during pregnancy. The prevalence of emotional, physical and sexual partner abuse during pregnancy was 32.4%, 13.4% and 6.7% respectively. Seventeen percent of the victims suffered all three types of violence and in two thirds the abuse was severe and repeated. Half of the abused women had experienced punches and kicks directed to the abdomen; however, only 14% had sought health care and very few had disclosed the abuse or contacted police or authorities. Adolescent mothers, unwanted pregnancy and late registration for antenatal care or no check-ups were more likely among victims. The access to social resources facilitated the women’s ability to cope with the abuse, but the pregnancy itself was a barrier to receiving support from family, friends or society. The ability to confront abuse was determined by a complex interplay of factors such as economic independence, severity of abuse, access to social resources, implications for important others (i.e. children), socioeconomic group and a personal ability to cope with social norms. Low social resources, high levels of emotional distress and attempted suicide were associated with violence during pregnancy. Abuse during pregnancy was also found as an independent risk factor for LBW. Sixteen percent of LBW was attributed to physical abuse by a partner during pregnancy. A significant association between abuse during the index pregnancy and SGA was found. Partner violence during the pregnancy, low social resources and emotional distress were associated with higher levels of salivary cortisol. Pregnant women with high cortisol values were significantly more likely to give birth to SGA babies. A substantial decrease of birthweight, 142 grams, was estimated to be associated with increases in cortisol due to violence exposure. Partner violence during pregnancy is a serious social problem that impacts the rights, health and wellbeing of both the woman and her unborn child. The studies call for prioritization of intervention programmes for prevention and detection of violence, treatment and rehabilitation of the victims and the perpetrators, and change of the structural causes producing violence in society.
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| 7. |
- Athanasiadou, Maria, et al.
(author)
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Polybrominated diphenyl ethers (PBDEs) and bioaccumulative hydroxylated PBDE metabolites in young humans from Managua, Nicaragua.
- 2008
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In: Environ Health Perspect. - : Environmental Health Perspectives. - 0091-6765 .- 1552-9924. ; 116:3, s. 400-8
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Journal article (peer-reviewed)abstract
- OBJECTIVE: Our aim was to investigate exposure to polybrominated diphenyl ethers (PBDEs) in a young urban population in a developing country, with focus on potentially highly exposed children working informally as scrap scavengers at a large municipal waste disposal site. We also set out to investigate whether hydroxylated metabolites, which not hitherto have been found retained in humans, could be detected. METHODS: We assessed PBDEs in pooled serum samples obtained in 2002 from children 11-15 years of age, working and sometimes also living at the municipal waste disposal site in Managua, and in nonworking urban children. The influence of fish consumption was evaluated in the children and in groups of women 15-44 years of age who differed markedly in their fish consumption. Hydroxylated PBDEs were assessed as their methoxylated derivates. The chemical analyses were performed by gas chromatography/mass spectrometry, using authentic reference substances. RESULTS: The children living and working at the waste disposal site showed very high levels of medium brominated diphenyl ethers. The levels observed in the referent children were comparable to contemporary observations in the United States. The exposure pattern was consistent with dust being the dominating source. The children with the highest PBDE levels also had the highest levels of hydroxylated metabolites. CONCLUSIONS: Unexpectedly, very high levels of PBDEs were found in children from an urban area in a developing country. Also, for the first time, hydroxylated PBDE metabolites were found to bioaccumulate in human serum.
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| 8. |
- Dahlblom, Kjerstin, 1950-
(author)
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Estrella : a gifted narrative
- 2009
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In: Childhoods Today. - : University of Sheffield. - 1753-0849. ; 3:1
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Journal article (peer-reviewed)abstract
- This paper analyses a short written account by a young Nicaraguan girl who narrates an experience she had while taking care of her small niece. She describes a turning point in her life, and narrative analysis was applied to interpret the meaning of her story. The importance and implications of becoming a mother are the key elements in her narrative. Her contribution was part of a larger study on sibling caretaking conducted in León, Nicaragua, in which multiple tools were used for exploration and analysis.
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| 9. |
- Tercero, F, et al.
(author)
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The epidemiology of moderate and severe injuries in a Nicaraguan community : a household-based survey
- 2006
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In: Public Health. - London : Saunders Elsevier. - 0033-3506 .- 1476-5616. ; 120:2, s. 106-114
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Journal article (peer-reviewed)abstract
- Although injuries constitute a major public health problem worldwide, the magnitude and nature of this problem is difficult to establish in low-income settings due to the lack of valid and representative data. In Nicaragua, several parallel studies have been carried out attempting to assess levels and patterns of injury using various sources of information. The objective of this study was to describe the magnitude and profile of moderate and severe injuries in a well-defined community in Nicaragua. The study was conducted using a household-based survey design. Randomized cluster sampling provided information from 10,797 households (63,886 inhabitants). The outcomes included fatal and non-fatal injuries registered during a recall period of 6 weeks. Seven percent of all. injuries were classified as moderate or severe. The estimated annual incidence rate of moderate/severe injuries was 27.6 per 1000 [95% confidence intervals (CI): 26.4-29.2], white the mortality and impairment rates were 108.9 (95% CI: 83.5-134.4) and 95.3 (95% CI: 71.4-119.2) per 100,000 inhabitants, respectively. Home and traffic areas were the main environments associated with injury occurrence. The most affected groups were the elderly, children and mates. No differences were found between urban and rural areas. Only 9% of all cases, including minor injuries, sought hospital treatment. The main causes of non-fatal injuries were falls, traffic and cuts, whereas fatalities were largely associated with intentional injuries. For every death due to injury, there was one permanent disability, 25 moderate/severe injuries and 354 minor injuries. This study provides a broad description of injury magnitudes and patterns in a defined Nicaraguan community, and demonstrates the aggregate injury pyramid of the same community. It also identifies the issue of severity and concludes with a recommendation to apply different criteria of severity. Our results support the call for a careful evaluation of injury data sources and severity scores when planning injury prevention programmes.
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| 10. |
- Cuadra, Steven
(author)
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Child labour and health hazards: chemical exposure and occupational injuries in Nicaraguan children working in a waste disposal site
- 2005
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Licentiate thesis (other academic/artistic)abstract
- About 600 children and teenagers work at Managua's landfill, the largest in Nicaragua. They collect and sort waste at the open dump, which covers an area of 7 km2 on the outskirts of the city on the shores of Lake Managua. Such work, which occurs in many large cities in developing countries, is considered to be one of the riskiest types of child labor that exists. Nevertheless, knowledge of such work and its risks is lacking.We investigated chemical exposure and risk of injury among 103 child laborers aged 6 to 15 years from Managua's landfill. Almost half of the children also lived in the dump area itself, while the rest lived in a nearby area, Acahualinca. For comparison, 102 children from Acahualinca and 34 children from central Managua, 10 km away, who did not work at the dump, were also studied. This provided the opportunity to also study the environmental exposure from the landfill. The children were interviewed about living conditions, working conditions, and all injuries that occurred at workplaces, at school, and at home during the last 12 months. They had to provide blood samples for examination of the levels of, among other things, heavy metals such as lead, mercury, and cadmium, and persistent organic environmental toxins such as pesticides and PCBs. We also investigated the levels of a relatively new organic environmental poison, the brominated flame retardant PBDE. At a later stage, soil samples were also collected from the landfill area and from Acahualinca for investigation of metal content.The children who worked at the landfill had higher levels of lead, mercury, and cadmium than the children in the comparison groups. One-third had blood lead levels higher than 100 μg/l, a level where measures to reduce exposure are clearly recommended. We also found that the children in the nearby residential area had higher lead levels than the children from central Managua. Although mercury levels were higher among the child workers, the levels were not such that they could be considered a present and clear health risk. Consumption of fish from Lake Managua only slightly affected mercury levels. The levels of several of the organic environmental toxins, especially PCBs, were also higher among the child workers than in the comparison groups. We know that PCBs, which have long been banned in the West, are still used in Central America, or stored in uncontrolled forms. The children in the comparison groups also had clearly higher levels of a breakdown product of the pesticide DDT and of PCBs than children in the USA and Western Europe. The levels of these substances are steadily decreasing in the Western world. There is extremely limited knowledge of how the development over time looks like in Central and Latin America because too few surveys have been carried out. Unexpectedly, we found extremely high levels of PBDEs among the children living and working at the dump, higher than previously reported. The children in the comparison groups also had unexpectedly high levels of these substances. This is the first investigation of human PBDE levels in Central and Latin America, and the findings clearly show that it is extremely important to study the spread of the new environmental toxins also in non-industrialized countries and among particularly vulnerable groups. Several of the different substances that we studied are toxic to reproduction, and they can negatively affect human reproduction and fetal development. It would therefore have been desirable to be able to make a balanced risk assessment, but this is not possible because there is a lack of knowledge about the synergistic effects of the substances, and especially about how other factors such as inadequate nutrition can further affect the risk picture. What is clear, however, is that the levels we found among the children are significant from a reproductive perspective, as many of the girls we surveyed will be mothers in a few years - a fifth of Managua's teenagers are pregnant or have given birth already.Injuries, which caused at least one day of absence from school or work, were seven times more common among the children working at the dump than among the children in the comparison groups. The vast majority of injuries occurred during work, corresponding to 2.2 injuries per 1000 working days. The children reported that approximately one in ten injuries had resulted in permanent disability or pain. We analyzed the injuries that occurred to clarify whether there were any clear injury patterns. Cuts and puncture wounds to the hands and feet in connection with material handling were most common and caused 70% of the injuries. This shows that simple protective measures – many children lack shoes and no one has gloves – could reduce the risk of injury. However, the most serious damage was caused by the vehicles at the dump.In our studies, we have wanted to measure exposure levels and quantify risks in order to clarify the situation of child workers, in the hope that increased knowledge and awareness can eventually contribute to change. We have also gained valuable knowledge about the levels of several common environmental toxins among ordinary poor city children in a developing country. This is something that has so far been too inadequately investigated.
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